Obstacles to alcohol, drug treatment higher for rural Americans

Rural Americans are less likely to initiate care for substance use disorders and to receive ongoing care compared with those who live in urban areas, according to a new study.

When they do access care, people who live in less populated areas are more likely to have to go outside their provider network to receive treatment, which comes with higher out-of-pocket costs, found a team of researchers at , the study’s senior author and an associate professor of health services management and policy at Ohio State.

“Rural areas are continuously plagued with a shortage of behavioral health providers and more limited health resources overall. These challenges are compounded by the fact that most insurance plans use managed care arrangements, some of which use highly limited provider networks,” Xu said.

One potential approach to tackling these problems could be the Collaborative Care Model, which has grown in popularity in recent years, she said: “This model allows primary care clinicians working with a behavioral health care manager, who often is not an advanced clinician, to treat substance use disorders in collaboration with a psychiatric consultant who doesn’t have to live and work in the area.”

In fact, the entire collaborative process of treatments, prescribing and ongoing care are typically delivered through virtual health appointments and billed through the patient’s primary care practice.

Raver said it’s important to note that while much of policymakers’ attention is focused on opioid use disorders, the disparities identified in this study exist across the spectrum of substance use disorders.

“A lot of policy focus has been on the opioid crisis, as it should be, but I think it’s interesting and troubling to see that, regardless of which substance we’re talking about, there is high out-of-network usage and low overall participation in care,” he said.

Study co-authors include Sheldon Retchin of Ohio State, Yiting Li of Nationwide Children’s Hospital and Andrew Carlo of Northwestern University.

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